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Impaired bone mineral accrual in prepubertal HIV-infected children: a cohort study
Cecília Zanin Palchetti1, Vera Lúcia Szejnfeld2, Regina Célia de Menezes Succi3
1Division of Nutrology, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Insights
HIV-infected children show poor bone mass accrual, with puberty offering some improvement. Monitoring nutritional status, including calcium and fat intake, and serum magnesium levels is crucial for bone health in these children.
Area of Science:
- Pediatric Endocrinology
- Bone Metabolism
- Infectious Diseases
Background:
- Human Immunodeficiency Virus (HIV) infection can negatively impact bone health in children.
- Bone mass accrual is a critical process during childhood and adolescence.
Purpose of the Study:
- To assess bone mass accrual in HIV-infected children.
- To identify clinical, anthropometric, dietary, and biochemical factors influencing bone mass in this population.
Main Methods:
- A longitudinal cohort study involving 35 HIV-infected children aged 7-12 years.
- Bone mineral density (BMD) was measured at two time points (T1 and T2).
- Patients were assessed for clinical, anthropometric, dietary, and biochemical parameters; pubertal status was evaluated at T2.
Main Results:
- Lumbar spine BMD Z-score did not improve, and total body BMD Z-score worsened over time.
- Pubertal children exhibited significantly higher bone mineral content and BMD compared to prepubertal children.
- Predictors of bone mass included age, BMI Z-score, serum magnesium, dietary calcium and fat intake, body composition, and pubertal status.
Conclusions:
- HIV-infected children experience compromised bone mass accrual.
- Puberty appears to enhance bone parameters in HIV-infected children.
- Adequate calcium and fat intake, along with monitoring nutritional status and serum magnesium, are important for bone health.
Objective:
To evaluate bone mass accrual and determine the influence of clinical, anthropometric, dietary and biochemical parameters on bone mass.
Methods:
A cohort study including 35 prepubertal HIV-infected children, between 7 and 12 years, attended at a referral center. At time 1 (T1) and time 2 (T2), patients were assessed according to clinical, anthropometric, dietary, biochemical parameters and bone mineral density (BMD). At T2, patients were divided into prepubertal and pubertal.
Results:
Despite the increase in bone mass absolute values, there was no improvement in lumbar spine BMD (LSBMD) Z-score (p=0.512) and worsening in total body BMD (TBMD) Z-score (p=0.040). Pubertal patients (n=19) showed higher bone mineral content (BMC) (p=0.001), TBMD (p=0.006) and LSBMD (p=0.002) compared to prepubertal patients. After multivariate linear regression analysis, the predictors of bone mass in T1 were age, BMI and HA Z-scores for BMC; BMI Z-score, adequate serum magnesium concentration and dietary calcium intake for TBMD; adequate serum concentration of magnesium, BMI and HA Z-scores for LSBMD. In T2, age, total body fat and lean body mass (kg) for BMC; BMI Z-score and puberty for TBMD; dietary fat intake, BMI Z-score for BMD and puberty for LSBMD.
Conclusion:
HIV-infected children have compromised bone mass and the presence of puberty seems to provide suitability of these parameters. Adequate intake of calcium and fat appears to be protective for proper bone mass accumulation factor, as well as monitoring nutritional status and serum magnesium concentration.
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